What is the Global Gag Rule?


Woman with a gag on her mouth and the word "Silence" written on it.
Source: CHANGE

The Mexico City Policy, also known as the Global Gag Rule (GGR) and called by the Administration of Donald Trump Protecting Life in Global Health Assistance, restricts non-U.S.-based non-governmental organizations from receiving U.S. foreign health assistance if they otherwise provide legal abortion services, counseling, or referrals with their own, non-U.S. funds.

Under the GGR, global health organizations are forced to choose between two options:  accept U.S. funds and be prohibited from providing abortion counseling, referrals, or services, as well as advocacy around abortion; or refuse U.S. funds and attempt to secure alternate sources of funding to continue providing comprehensive health services and advocate for law reforms to reduce unsafe abortion. First enacted by President Ronald Reagan in 1984, the policy has since been reenacted by every Republican president and rescinded by every Democratic president. Historically, GGR restrictions have applied to funding for international family planning.

Under these previous iterations, the GGR has: 

  • Prevented women and girls from accessing contraception and safe abortion consistent with the laws in their countries.  
  • Been associated with increased abortion rates.
  • Been associated with increases in unintended pregnancies. 
  • Led to negative child health outcomes.  
  • Hampered HIV prevention efforts.  
  • Forced health clinics to close. 
  • Obstructed communities in rural access to health care. 
  • Removed funding from humanitarian settings, which could have negatively affected the speed and effectiveness of humanitarian aid.

However, under the Trump administration, the GGR expanded to cover all global health assistance furnished by U.S. agencies, including but not limited to HIV/AIDS, maternal and child health, malaria, tuberculosis, nutrition, non-communicable diseases, and even water, sanitation, and hygiene. Affected funding exceeded $9 billion annually, including $6 billion in funding to prevent and treat HIV/AIDS.1 The fallout of this policy has been severe and ongoing. According to a study by the Kaiser Family Foundation, over 1,275 foreign NGOs were affected by the rule2. Clinics and organizations around the world lost critical funding and were forced to cut or shut down critical health services. AmfAR, the Foundation for AIDS Research, found that the policy derailed progress on sexual and reproductive health and HIV epidemic control by U.S.-funded global health programs, particularly the flagship President’s Emergency Plan for AIDS Relief (PEPFAR).3 The GGR also damaged long-standing collaborations that organizations rely on to deliver comprehensive care. By banning some collaborations between non-governmental organizations according ability to comply with the GGR, this policy eroded the health system’s ability to provide quality care for an array of health needs.4 Many organizations, confused and concerned about the reach of the GGR, engaged in self-censorship on other topics not even covered by the policy, such as menstrual hygiene, gender-based violence, and contraception. 5

On January 28, 2021, President Joe Biden signed a Presidential Memorandum revoking the GGR, a move that puts healthcare providers around the world back on track to providing lifesaving sexual and reproductive healthcare to women and girls. But the long-lasting impacts of the Global Gag Rule do not go away with the signing of a Presidential Memorandum. In order to reinvest in medically justified, rights-based care, global health organizations must trust that this policy will never again harm women and girls around the world. Congress can provide a permanent legislative end to the GGR, though passage of the Global HER Act or similar legislation that would prohibit U.S. presidents from reinstating the policy.



1 CHANGE (2018). Prescribing chaos in global health. The GGR from 1984-2018. Washington DC. Retrieved from
2 Moss, K., Kates, J. (December, 2017) How Many Foreign NGOs Are Subject to the Expanded Mexico City
Policy? Kaiser Family Foundation. Recovery from: http://files.kff.org/attachment/Issue-Brief-How-
3 AmFAR (January, 2019). The Effect of the Expanded Mexico City Policy on HIV/AIDS Programming:
Evidence from the PEPFAR Implementing Partners Survey. Washington: AmFAR. Retrieved from
4 Starrs, A., Ezeh, A., Barker G. et al. (2018) Accelerate progress—sexual and reproductive health and
rights for all: report of the Guttmacher–Lancet Commission. The Lancet, 391(10140), 2642-2692.
Retrieved from https://www.thelancet.com/action/showPdf?pii=S0140-6736%2818%2930293-9
5 Mavodza, C., Goldman, R. & Cooper, B. (2019). The impacts of the GGR on global health: a scoping
review. Global Health Research and Policy. 4, 26 (2019) doi:10.1186/s41256-019-0113-3